Table 5. Summarized outcomes in Grading of Recommendations Assessment, Development and Evaluation (GRADE) for each major intervention.
| Table 5 summary of findings: | |||||
|---|---|---|---|---|---|
| Local infiltration analgesia compared to Placebo or no intervention for pain after TKA | |||||
| Patient or population: pain after TKA. Setting: The immediate postoperative setting. Intervention: Local infiltration analgesia. Comparison: Placebo or no intervention | |||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | |
| Risk with Placebo or no intervention | Risk with Local infiltration analgesia | ||||
| Morphine consumption assessed with: 0–24 hour postoperative | The mean morphine consumption was 38.9 mg | The mean morphine consumption in the intervention group was 13.4 mg lower (8.5 lower to 18.2 lower) | - | 960 (12 RCTs) | ⨁⨁◯◯ LOW a,b |
| Pain score 6 h postoperative at rest assessed with: VAS 0–100 | The mean pain score 6 h postoperative at rest was 42 mm | The mean pain score 6 h postoperative at rest in the intervention group was 14 mm lower (9 lower to 20 lower) | - | 959 (13 RCTs) | ⨁⨁◯◯ LOW a,b |
| Pain score 24 h postoperative at rest assessed with: VAS 0–100 | The mean pain score 24 h postoperative at rest was 36 mm | The mean pain score 24 h postoperative at rest in the intervention group was 10 mm lower (6 lower to 13 lower) | - | 939 (13 RCTs) | ⨁⨁◯◯ LOW a,b |
| Pain score 6 h postoperative at movement assessed with: VAS 0–100 | The mean pain score 6 h postoperative at movement was 50 mm | The mean pain score 6 h postoperative at movement in the intervention group was 16 mm lower (9 lower to 23 lower) | - | 361 (6 RCTs) | ⨁⨁◯◯ LOW a,b |
| Pain score 24 h postoperative at movement assessed with: VAS 0–100 | The mean pain score 24 h postoperative at movement was 59 mm | The mean pain score 24 h postoperative at movement in the intervention group was 14 mm lower (8 lower to 20 lower) | - | 377 (6 RCTs) | ⨁⨁◯◯ LOW a,b |
| Postoperative nausea and vomiting (PONV) assessed with: Number of events | 273 per 1,000 | 186 per 1,000 (147 to 235) | RR 0.68 (0.54 to 0.86) | 795 (10 RCTs) | ⨁⨁⨁◯ MODERATE a |
| Pruritus assessed with: Number of events | 314 per 1,000 | 245 per 1,000 (141 to 417) | RR 0.78 (0.45 to 1.33) | 368 (6 RCTs) | ⨁◯◯◯ VERY LOW a,b,c,d |
| Length of stay (LOS) | The mean length of stay was 5.6 days | The mean length of stay in the intervention group was 1 days lower (1.9 lower to 0.2 lower) | - | 449 (8 RCTs) | ⨁⨁◯◯ LOW a,b |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; MD: Mean difference; RR: Risk ratio | |||||
| GRADE Working Group grades of evidence: High quality: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | |||||
a. There were studies of unclear and high summarized risk of bias.
b. There was heterogeneity as noted by I^2.
c. There were less than 400 participants in total.
d. 95% confidence interval includes 'no effect'.